Last year, Sal Gomez noticed that he was experiencing pain in his right testicle and lower back. The third-year medical student thought he might have pulled a muscle while working or exercising. When the pain did not go away, he consulted his doctor and learned the reason for his pain: he had testicular cancer.
“I really thought I was hurting myself and I was very busy with the surgical rotation. It’s like a 5 a.m. to 5 p.m. kind of thing,” Gomez, 26, a medical student at Ohio State College of Medicine, told TODAY.com. “I was shocked to be 25 and diagnosed with cancer.”
Gomez is sharing her story to raise awareness for testicular cancer, a rare cancer that primarily affects teens and young adults.
“We should talk about it more because it’s the most common, though rare, cancer in young men,” he says. “You are in the prime of life.”
‘Strange’ pain leads to diagnosis
After spending 12 hours in the hospital as a medical student on a surgical rotation and then studying all night, Gomez thought, when he first felt the pain in his testicle and back, that he had pulled a muscle.
“I didn’t really know why it was happening there. I had never had anything like it before,” he recalls. “After two weeks it wasn’t really going away or getting better.” Gomez performed a self-examination of his testicle and didn’t feel any “big or bumpy,” but he still made an appointment with his primary care doctor. “He wasn’t super concerned about what was going on,” Gomez says. “He ordered a bunch of labs and an ultrasound.”
Gomez began to feel better, and with his busy schedule, he postponed his ultrasound. From what he had learned in medical school, he didn’t think he had the classic signs of testicular cancer.
“When you find out about testicular cancer, you learn about symptoms like a lump,” he says. “You really don’t think cancer is painful. You usually think of a pea-sized lump (on) a testicle that isn’t painful but may have some sort of enlargement.
But the pain returned and in January he resigned himself to having the ultrasound.
“The pain really shouldn’t come and go,” Gomez says. “I did another exam, and at the time, I didn’t feel like much there.”
But the ultrasound found a mass.
“There aren’t really a lot of benign tumors in the testicle, and mine looked particularly cancerous,” he says. “I was really surprised.”
Soon after, Gomez met with an oncologist to come up with a treatment plan. Because he also had back pain, doctors feared the cancer had spread.
“A few days later, I had a CT scan of my abdomen and my (pelvis) which revealed what the back pain was,” Gomez explains. “I had these very enlarged lymph nodes in the lower back area, around where my kidneys are.”
The size of his lymph nodes was a concerning finding because the testicles often move into the kidneys, Gomez says. But fortunately, further analyzes revealed that it had not spread.
About a week later, he had his testicle removed and learned he had stage 2 testicular cancer. He would need chemotherapy.
“I did nine weeks of chemotherapy after removing the primary tumor. It was pretty brutal,” Gomez says, adding that her treatment often caused nausea.
Follow-up scans revealed that her lymph nodes responded somewhat to the chemo, but they were still enlarged enough that Gomez’s doctors believed there might still be cancer. So, they performed lymph node dissection, an eight-hour procedure to remove them.
“At the end of June, the pathology returned without any viable cancer,” Gomez explains.
According to the American Cancer Society, testicular cancer usually affects young people.
“It’s a leading cancer in young men in their teens to maybe early 30s. So it’s a big problem for young men,” Dr. J. Paul Monk, medical oncologist at The Ohio State University Comprehensive Cancer Center “He’s not a top killer, thankfully, because he’s being treated so well.”
People with testicular cancer normally have surgery to remove the testicle and then may receive chemotherapy.
“Surgery is the mainstay of treatment for testicular cancer,” Monk says. “He really responds so well to chemotherapy in the advanced and early stages.”
Monk says if caught early, some patients don’t need chemotherapy or radiation. Doctors still don’t know why it affects younger people more than older people. People who have an undescended testicle at birth may be at increased risk of developing testicular cancer, Monk says. The most noticeable symptom is a lump in the testicle, so doctors recommend that men familiarize themselves with what is normal for their bodies.
“We say do a self-testicle exam once a month,” Monk says. “If you notice a lump or something wrong, let someone know because…sooner than later is always good.”
Surgical removal of a testicle affects fertility, and often doctors encourage their patients to save sperm in case they face fertility issues later. But there is good news about testicular cancer.
“We’re still very proud that even in the advanced setting, we’re planning a cure,” Monk says. “It’s one of the brightest spots in oncology because (testicular cancer) has gone from a mostly fatal disease in advanced settings to a mostly curable disease.”
Faculty of Cancerology and Medicine
As a medical student, Gomez had access to medical journals, so he could have researched more than the average patient. But he felt enough anxiety to try not to delve too deeply into the literature about his cancer and its treatment.
“I was trying to limit myself,” he says. “You learn it and then it happens to you. … It’s a really weird experience.
Recovering from her lymph node surgery has been accompanied by complications. He started retaining fluid in his abdomen, which made it difficult for him to retain food. They emptied several liters from his abdomen.
Gomez initially felt better afterwards, but two weeks later had to return to the hospital due to more fluid.
“I had five liters taken out, which was a lot,” he says. “It was quite difficult because I couldn’t really sleep if I had all the liquid in me. I was super nauseous.
Luckily the fluid buildup stopped and he was slowly able to resume his regular activities and even go to the gym. Although he gets regular scans to make sure the cancer doesn’t come back, he has a low recurrence rate. He recently got engaged and is looking forward to starting his fourth year of medical school, which he had to postpone for his treatment.
Gomez says testicular cancer comes with a stigma and he hopes people will be less ashamed to talk about it.
“I had to tell everyone that I’m going to lose my testicle, and on top of that I think the most important thing is – and I’m an example of that – men don’t want to go to the doctor “, Gomez said. “If we don’t talk about it, how can we find these things really dangerous?”
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